Embed Size (px)
Citation preview
Sky Lakes Discipline (Three Possible Entry-Level Discipline)
National Norms for Discipline (Single Entry-Level Discipline)
Sky Lakes Truncates Disciplinary Process
Oregon Nurses Association Bargaining Unit Newsletter
Sky Lakes Medical Center (SKY)
Newsletter for Nurses March 19, 2018
Many employees do not understand the disciplinary procedures used by their employers. In
this article, we compare best practices of corrective action with the system used at Sky
Lakes Medical Center (SKY). As we shall see, our employer’s practices, are at variance with
national norms (see table below).
In every workplace, some behaviors are simply unacceptable and they should be dealt with
severely and immediately. As nurses, we prioritize patient care. Employees who have been
proven to abuse patients or divert drugs should be disciplined and fired in many cases.
However, lesser offenses can be corrected through education.
As a target, national norms envision discipline as a series of corrective actions to improve
the behavior of employees. It begins with the employer’s responsibility to inform, investigate,
and judge whether employees are misbehaving. This approach embraces the concept of
progressive discipline, a step-wise approach that models and improves employee’s
behavior.
In most cases, when an employee has been judged to violate a policy, the appropriate initial
response is to provide coaching and counseling. This informal discipline does not appear in
an employee’s personnel file in human resources. It a gentle corrective to inappropriate
behavior.
Only when the misbehavior continues after coaching should the employer move to use (continued on page 2)
Officers
•President:
Brent Powers (Post-Surgical)
•Vice President:
Sabrina DeVall (PCU)
•Secretary:
Rose Keppinger (Medical)
•Treasurer:
Maria Pappas (Flex)
•Grievance Officer:
Juliann Underwood (OR)
•PNCC Chair:
Monica Meier (ICU)
Oregon Nurses Association 18765 SW Boones Ferry Road Suite 200, Tualatin, OR 97062
1-800-634-3552 within Oregon www.OregonRN.org
Labor Relations Representative Gary Aguiar, Ph.D. 503-444-0690 (call/text) [email protected]
formal discipline, i.e., insert a written
notification in an employee’s file.
Formal discipline occurs in
progressive steps (see chart on page
1). Only in the most extreme cases
should the employer skip disciplinary
steps.
We have communicated with nurse
leaders at other facilities and
compared their experiences to ours.
In our view, Sky Lakes administration
too often skips “Oral Counseling” as a
corrective technique.
From our research and experiences,
Sky Lakes Medical Center uses
formal discipline too quickly and too
harshly. Our employer often moves to
suspension (unpaid leave) upon a
first minor violation. The chart on
page 1 shows that in some cases
(“thumbs up”), the employer follows
the normal step-by-step progression.
However, in many cases, (designated
by the ) the employer skips steps.
So, an employee with one or two
relatively minor violations could face
immediate termination (be fired) upon
another minor violation.
Of 55 “unsatisfactory behaviors” listed
in Sky Lakes policy on employee
behavior, 32 allow the manager to
skip at least one step in the
progressive chain of discipline (see
chart on page 3). Restated, a majority
of named behaviors are disciplined by
skipping at least one step (58
percent), which puts the employee
one step closer to termination than is
suitable. Moreover, some of these
policies are vague and subjective,
which allows a manager the ability
interpret broadly and therefore skip
steps inappropriately.
As we stated above, some extremely
dangerous actions require severe
responses. However, Sky Lakes
policy states that any conduct that
may have a negative impact on the
hospital’s image should result in a
stage two discipline, which may
include suspension. Indeed, an
employee can be placed on unpaid
leave if anyone, including the
patient, can identify themselves from
the remarks an employee makes in
public. In our experience, no other
Oregon hospital suspends an
employee for privacy violations
beyond the normal HIPAA identifiers.
Several nurse leaders have raised
concerns that our hospital is more
concerned with their reputation than
patient care. To repeat, we agree that
behaviors that harm a patient should
be disciplined sternly. However, those
actions that merely affect the image
of the business do not rise to that
level of severity. Employees can be
coached, and repeat violators can
receive a stage one discipline.
As an information request, we asked
the employer for recent disciplinary
activity on Red Rule violations,
including privacy and HIPAA. In a
recent six-month period, the employer
reported they issued 37 Red Rule
disciplines, which include nurses and
other employees. A monthly average
of six disciplines on Red Rule alone is
much higher than similar size
hospitals in our region. For example,
at McKenzie-Willamette Medical
Center (MWMC) in Eugene/
Springfield which is somewhat larger
than our hospital, nurses average one
discipline of any kind per month.
Of these 37 violations, five employees
were suspended and eleven received
written warnings. Restated, in nearly
half of the disciplinary actions (43
percent), the employer skipped the
first step in the progressive chain (i.e.,
stage one or “Verbal Warning with
Written Documentation”).
This authoritarian work environment
does not lead to healthy relationships
Oregon Nurses Association | 18765 SW Boones Ferry Road, Suite 200 | Tualatin, OR 97062 | 1-800-634-3552 within Oregon | www.OregonRN.org
(continued on page 3)
Sky Lakes Truncates Disciplinary Process (continued from page 1)
Paid Time Off (PTO) Credit for 0.9 Nurses In November, we settled a grievance that corrected the Sky Lakes Medical Center (SKY) error in awarding PTO
credits to certain nurses. Our contract provides that nurses who work a 0.9 FTE should receive an annual additional
208 hours of PTO. The employer limited the number of total hours a nurse could be awarded in a pay period, which
resulted in many nurses losing PTO hours in the last two years. Through our collective joint efforts, the employer
agreed to credit those nurses the additional hours, which were placed in their PTO banks in February. Working
together, nurses successfully advocated for each other!
Page 2 Sky Lakes Medical Center
Verbal Warning with Written Documentation
(should be the initial step for almost all discipline)
Written Warning (Skips one step of discipline)
Suspension without Pay or Second Written Warning (Skips two steps of discipline)
23 19 13
Posting, altering or removing any matter on bulletin boards. *
Scuffling or running. *
Excessive personal talking. *
Disruptive personal behavior. *
Parking violations. *
Violating a safety rule. *
Leaving Medical Center during shift.
Excessive tardiness.
Tobacco or e-cigarettes use on premises.
Threatening or vulgar language. *
More than 3 Time Card missed punches in a pay period. *
Contributing to disorderly or sanitary conditions. *
Unauthorized operation of equipment. *
Failure to share or seek information that jeopardizes patient care.
Wasting time or loitering. *
Patient abuse or neglect, including verbal abuse.
Conduct/behavior that may have a negative impact on Medical Center’s image in the community.
Not following grooming or dress standards.
Unauthorized distribution of written matter.
Unauthorized vending or soliciting contributions on premises.
Making false, vicious, or malicious statements about a coworker.
Chronic absenteeism.
Fraudulent time sheet.
Abuse of sick time.
Careless waste of materials/supplies.
Falsifying Medical Center records.
Misdemeanor conviction related to work duties.
Accessing unauthorized confidential information or disclosing such information to unauthorized persons.
Sleeping on the job.
False statements on employment application.
Performing duties not legally licensed to perform.
Threatening or intimidating others on premises.
Unauthorized use of drugs on premises.
Reporting to work under the influence.
Felony conviction related to work duties.
* = Initial offense may be corrected with informal coaching (“Oral Counseling”), which should NOT appear in your HR personnel file.
Page 3 Sky Lakes Medical Center
Oregon Nurses Association | 18765 SW Boones Ferry Road, Suite 200 | Tualatin, OR 97062 | 1-800-634-3552 within Oregon | www.OregonRN.org
“Unsatisfactory Behaviors” at Sky Lakes Which May Lead to Initial Discipline
Sele
cte
d e
xa
mp
les o
f b
eh
avio
r fo
r w
hic
h a
n e
mp
loye
e m
ay r
ec
eiv
e d
iscip
lin
e
To
tal
nu
mb
er
of
beh
avio
rs
liste
d
between nurses and their managers. An extreme disciplinary regime creates a profoundly intimidating atmosphere,
which corrupts working relationships and weakens loyalty to the hospital. Less than half of the nursing graduates
from a local program decided to start their nursing career in Klamath Falls, despite having ample job opportunities.
There are over 70 RN vacancies posted in Klamath Falls as of today, per indeed.com. Moreover, lower employee
morale encourages nurses’ mobility from our community, which leads to high turnover and higher cost, including a
larger number of travelers than comparable hospitals.
In numerous conversations with our coworkers, we have found that junior nurses at Sky Lakes question whether
they want to remain. As they approach the middle of their careers (i.e., five to eight years’ experience), they evaluate
whether this is the community where they want to put down deep roots. When they see the harsh and immediate
discipline from the employer, it tilts them to leaving. Instead, our employer should support and encourage these loyal
employees who are productive members of our community.
Sky Lakes Truncates Disciplinary Process (continued from page 2)
Oregon Nurses Association | 18765 SW Boones Ferry Road, Suite 200 | Tualatin, OR 97062 | 1-800-634-3552 within Oregon | www.OregonRN.org
We settled three recent grievances
that corrected extreme and
unnecessary discipline. In each
case, the aggrieved lead the way
for others, self-advocating for their
rights. Moreover, each of them
were strongly supported by our
Oregon Nurses Association (ONA)
leadership, who attended the
grievance meetings in force.
Posting on Social Media
In one case, Nurse A received a
stage two discipline (“Written Warning
with 24 hours of suspension”) for
posting a comment on social media.
Her posting did not identify any
patient; it contained none of the
standard HIPAA identifiers. Nurse A
offered a general comment about the
widespread use of drugs in our
community.
The employer contends that because
someone who was already
knowledgeable about the situation
might be able to identify the person
she posted about, it harmed the
reputation of the hospital. Hence, they
maintain her action merited an
advanced discipline (i.e., at stage
two). We offered a strong case that
the posting was NOT a HIPAA or
privacy violation by widely accepted
standards. Further, the discipline was
strict and extreme, including a
suspension from work (unpaid leave
of 24 hours) that was beyond the
national norms.
We filed a Step three grievance, held
before the hospital CEO. The
employer proposed to pay her wages
for the suspension, including all
differentials, but upheld the formal
discipline at stage two. Nurse A
accepted this compromise.
Wrong Meds Upon Discharge
In a second case, Nurse B received a
formal discipline, when a patient was
discharged with medications from
another patient who had been
discharged two weeks prior.
Evidently, the meds were locked in a
safe drawer for two weeks and
somehow ended up attached to the
wrong patient. This happened during
a particularly busy time in a busy
shift.
In researching the facts for our
grievance, we discovered all sorts of
errors in the medical drawers and
boxes. Many were mislabeled with
past patients’ names. The employer
held that the nurse was responsible
for checking the meds. Nurse B is a
highly-regarded nurse, who is a
widely respected by her peers. She is
well-known for her careful attention to
detail, especially around meds and
discharges, as noted by her manager.
A few weeks earlier, Nurse B
received her first-ever discipline, a
stage two (“Written Warning with 24
hour suspension”) on a posting to
social media similar to Nurse A. Thus,
the employer contended they could
have moved to termination (i.e., fired
the nurse) over this second violation.
Instead, they decided to give her a
second a stage two discipline
(“Written Warning in lieu of
suspension”).
Given the widespread reporting of
problems in the medication storage
process, we argued in our grievance
that it was unfair to hold one
individual, Nurse B, solely
responsible. A systemic error, further
complicated by inappropriate
behavior by other employees, lead to
this mistake. As many as six other
patients were in that room and
evidently no one checked the drawer
during that two-week period. The
employer agreed to reduce the stage
two (“Written Warning”) to a stage
one (“Verbal Warning with Written
Documentation”). Nurse B accepted
this reduction and closed the
grievance.
EKG Printout
In a third case, Nurse C received a
stage one (“Verbal Warning with
Written Documentation”) related to a
problem with the new EKG machine.
Evidently, no one knew when an
Three Recent Grievances Settled
Page 4 Sky Lakes Medical Center
Extreme Discipline Removed
Oregon Nurses Association | 18765 SW Boones Ferry Road, Suite 200 | Tualatin, OR 97062 | 1-800-634-3552 within Oregon | www.OregonRN.org
Our Nursing Practice Consultant Reports
Dear Sky Lakes Nurses,
I had a great visit with you all in January! When I first
announced I was coming to visit, there was a lot of interest
around learning about Unit Practice Committees (UPCs). It’s
exciting to see this growing at your hospital and to see how
many nurses want to have this in their units. I want you to
have this too!
When I spoke with nurses at Sky Lakes about UPCs, I
wanted to know, what is it that you want? What do you want
this to look like? And, what did you want to be able to do
with your UPCs? Here is what I heard from you:
You want ownership of your nursing practice and of the patient outcomes on your units. Specifically, you want to
improve processes on your units to ensure that your patients are being cared for safely, that the unit is being
staffed appropriately, and that your nursing licenses are protected. You also want to work together with other
nursing units and other departments, like pharmacy or housekeeping, on the issues that affect everyone
You want a UPC that is led by nurses with a nurse as the chair. As part of the UPC, you also want the certified
nursing assistants (CNAs) and the manager of the unit to be a part of it. You think it will be important to have a
way of communicating to staff on the unit who are not an active part of the UPCs as well, and to be able to get
their input on the work of the UPC. And you would really like the ability for your UPCs to work autonomously,
even having their own budget to be used as the UPC decides!
With your UPCs, you want to be able to improve patient safety and satisfaction. You also want to improve staff
morale, continuing education, and retention for nursing staff at Sky Lakes. In summary, you told me you want to have
a more professional nursing practice! You felt that if the UPCs were designed to work for you, then you would work
with them to continue to make your workplace great.
(continued on page 6)
Nicole Heard from YOU About Unit Practice Committees!
employee hand-enters a patient’s name in the EKG (rather than an electronic order), the machine will print out the
name of the last patient whose order was sent to the EKG electronically. Nurse C was eloquent in defending her
actions, she maintained she expected to be set up for success in her job. Yet, this machine was producing
inaccurate information unbeknownst to anyone. The employer held that the nurse was obligated to check the name
on the printout. Yes, but we argued, it is not necessary to place a formal discipline in Nurse C’s file. In response to
our grievance, the employer agreed and removed the verbal warning.
Three Recent Grievances Settled (continued from page 4)
Page 5 Sky Lakes Medical Center
Oregon Nurses Association | 18765 SW Boones Ferry Road, Suite 200 | Tualatin, OR 97062 | 1-800-634-3552 within Oregon | www.OregonRN.org
Don’t Miss Important ONA Emails ONA wants to make sure all members receive timely communications, ensuring you have the most up-to-date information on your contract, bargaining issues, upcoming votes, nursing research, practice issues and workplace policies. If you are not receiving ONA emails, we can help.
First, check to make sure ONA emails are not being filtered into a junk, spam or clutter folder. Many email providers, like Comcast, Yahoo and Gmail, have built in Spam/Junk filters or blockers. The filters are intended to prevent you from getting junk mail or spam, but it can also unintentionally block emails you want to receive. If ONA emails are in one of these folders, flag them as “not junk” and add [email protected] to your safe sender list.
If there are no ONA emails in those folders and you still aren’t receiving ONA emails, there are various causes listed to the right.
You can fix most problems by simply emailing ONA at [email protected] with your name, personal email address and the name of the facility you work at in the body of the email.
We will update our records to ensure you don’t miss future ONA emails.
Common Reasons for Not Receiving ONA Emails
1. Mislabeled: Emails from ONA are being flagged as junk or
spam by your email service provider.
2. No Email: ONA does not have an email on file for you.
3. Bad Email: ONA has an incorrect or outdated email on file.
4. Blocked: Due to several failed delivery attempts, our system
has stopped attempting to send emails to your email
address.
5. Opted Out: You have opted out of receiving emails.
6. Work Email Filters: Some health care
systems filter out ONA emails so nurses
don’t receive ONA-related emails. This
is why we encourage nurses to use
their personal email addresses
instead of work emails.
Fixing Problems to Receive ONA Emails
1. Check your junk/spam/clutter folder for ONA
emails: Flag ONA emails as “not junk/spam” and add
[email protected] to your safe sender list.
2. Email ONA: To fix reasons 2-6, simply email ONA at
[email protected], and include your name, personal email and
facility you work at in the body of the email.
Nicole Heard from YOU About Unit Practice Committees! (continued from page 5)
This is something different for the nurses at Sky Lakes. It is nurse driven, nurse created, and nurse
maintained!
The next step in this process will be the creation of the house-wide committee, the Hospital Nursing
Practice Council (HNPC), and the structure of the UPCs. This work will be done
collaboratively with your Chief Nursing Officer, nurse managers, and bedside
nurses.
I look forward to seeing this work continue at Sky Lakes and will continue to
support you through it! As always, I am also here to support you with any
nursing practice issues or concerns. Reach out to me at any time!
Yours,
Nicole Cantu, RN-BC BSN
Nursing Practice Consultant - [email protected] - 541-631-4114
Nicole Cantu, RN-BC BSN
Nursing Practice Consultant
Page 6 Sky Lakes Medical Center
